Elbow prosthesis and method for use

ABSTRACT

The elbow prosthesis includes an ulnar component that has a bearing end and a stem. The stem is attached to the bearing end and extends in a distal direction from it. The elbow prosthesis also has a humeral component that includes a holder end and a stem with the stem extending in a proximal direction from the holder end. The prosthesis further includes at least one bearing member that is connected to the holder end with the bearing end being attached within the holder end to allow for rotation and articulation against the at least one bearing member. The bearing end and holder end are attached to each other by a coupling mechanism that includes an opening positioned on the posterior aspect of the holder end and a mating surface on the bearing body. A method of using the elbow prosthesis and a total elbow prosthesis kit are also disclosed.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a divisional of U.S. application Ser. No. 13/219,008filed Aug. 26, 2011, which claims priority to U.S. ProvisionalApplication No. 61/377,511 filed Aug. 27, 2010, each of which are herebyincorporated herein by reference in their entireties.

TECHNICAL FIELD

The present invention relates generally to the field of orthopedics andmore specifically, but not exclusively, to artificial joints, and inparticular, to an elbow joint prosthesis.

BACKGROUND OF THE INVENTION

In the human elbow, three degrees of freedom are present. These areflexion-extension, varus-valgus carrying angle and axial rotation.

The various elbow prosthesis available in the marketplace today havebeen constructed as a replacement for the natural human elbow. The twobasic types of elbow prosthesis known in the prior art aresemi-constrained and unconstrained. In semi-constrained prosthesis, theprosthetic joint is held together mechanically, by components of theprosthesis. Whereas in an unconstrained device, the prosthetic device isheld together by the patient's natural soft tissues.

In each of these devices, one portion of the prosthesis is implanted inthe humerus of the patient and the other portion is implanted in theulna. The two portions then mate in some manner to allow articulation ofthe joint. Importantly, absent from the marketplace is a device that canbe implanted when either the humerus or ulna and/or both bones arecompromised either from disease or injury.

Prosthetic elbows currently marketed typically can be implanted tooperate in one of two ways. These two ways are an unconstrained orunlinked manner and the other way is a semi-constrained or linkedmanner. Unconstrained prosthetic elbows are more generally indicated forosteoarthritic or post traumatic patients with strong soft tissues aboutthe elbow.

Typically, unconstrained elbows are designed with, for example, a metalhumeral articulating surface and a polyethylene ulnar articulatingsurface. Each of these components having matching convex and concavesurfaces, respectively.

The semi-constrained prosthesis is usually used in patients that aresuffering from an inflammatory disease. The inflammatory disease resultsin the patient having weaker soft tissue and significant bone erosion.The weaker soft tissue and bone erosion makes the use of anunconstrained elbow more difficult in that the soft tissues are not ofsufficient strength to properly contain the prosthetic components incontact with each other. A semi-constrained prosthesis typically uses alinkage pin at the elbow axis of rotation. Most commercially availableelbow devices make use of a locking axis pin as the main element ofarticulation for the semi-constrained form of the elbow prosthesis.

A long standing need has existed for the orthopedic surgeon to haveavailable an elbow prosthesis that addresses the clinical problems thatresult from a post-traumatic injury to the elbow. More specifically,currently no elbow implant designs exist that are specifically indicatedfor use to treat complex fractures of the distal humerus and/or proximalulna.

Please note that for the purposes of this disclosure, the terms“prosthesis,” “implant” and “device” may be used interchangeably andhave the same meaning herein.

SUMMARY OF THE INVENTION

Advancement of the state of total elbow arthroplasty and the surgicalmanagement relating to the clinical presentation of complex trauma tothe elbow is believed desirable. Aspects of the present inventionprovide for a modular and versatile elbow prosthesis, methods for usethat can solve the long-standing need for treatment of traumaticinjuries to elbows and a surgical kit that contains numerous sizes ofthe modular components of the elbow prosthesis.

The present invention provides in one aspect an elbow prosthesis havingan ulnar component with a bearing end and a distally extending stem thatis coupled to the bearing end. The prosthesis also has a humeralcomponent which includes a holder end and a proximally extending stemwith at least one bearing member that is coupled to the holder end. Thebearing end is configured to be rotatably coupled within the holder endand articulate against the at least one bearing member.

The present invention provides in another aspect, a method for using theelbow prosthesis. The method may include the step of obtaining an elbowprosthesis that includes an ulnar component having a bearing end and adistally directed stem. The prosthesis may also include a humeralcomponent that has a holder end and stem that extends in a proximaldirection and at least one bearing member that is attached to the holderend. The method may further include the step of making an incision inthe patient and dissecting the surrounding soft tissue from the elbowjoint. An additional step may be to determine the proper size for theulnar component and the humeral component. Another step may be to cutand prepare the ulna and the humerus. Further steps may be to secure thehumeral component into the humerus of the patient and couple the ulnarcomponent to the implanted humeral component resulting in the bearingend of the ulnar component being operatively associated with the holderend of the humeral component to allow movement between the ulnarcomponent and the humeral component. The method may also includeinserting and securing the ulnar component in the ulna. Finally, themethod may have the step of closing the incision in the patient.

The present invention provides in another aspect, a total elbowprosthesis kit that includes a plurality of humeral components with eachof the humeral components having a holder end and a stem extending in aproximal direction. The kit also includes a plurality of ulnarcomponents with the ulnar components having a bearing end and a modulardistal stem attached to the bearing end or an ulnar component that has afixed stem that is attached to the bearing end. The kit also includes aplurality of interchangeable bearing members for fixation to the holderend.

The present invention provides in a further aspect, a semi-constrainedtotal elbow prosthesis that includes an ulnar component having a bearingend and a stem with the stem being coupled to the bearing end andextending in a distal direction from the bearing end. The prosthesisalso has a humeral component that has a housing member and a proximallyextending fixed stem. The semi-constrained elbow prosthesis may alsohave at least one bearing member that is coupled to an inside surface ofthe housing member. The bearing end is configured to be inserted intothe housing member and articulate against the at least one bearingmember to allow for motion between the ulnar component and humeralcomponent.

The present invention in yet another aspect, a total elbow prosthesishaving an ulnar component with a bearing end and a modular stem that isconfigured to fit inside a bone. The prosthesis also has a humeralcomponent that includes a stem and a distal yoke with the yoketerminating in a pair of spaced apart arms that each have a distalbearing holder member. At least two bearing members are also included inthe prosthesis with the at least two bearing members being attached toan inner surface of each of the bearing holder members. The prosthesishas a coupling mechanism that is positioned between the pair of spacedapart arms and functions to attach the ulnar component to the humeralcomponent and allow the ulnar component to rotate relative to thehumeral component along the sagittal plane.

Details of these aspects of the invention, as well as further,additional features and advantages will become more readily apparentupon review of the following drawings and claims. Other embodiments andaspects of the invention are described in detail herein and areconsidered a part of the claimed invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The subject matter which is regarded as the invention is particularlypointed out and distinctly claimed in the claims at the conclusion ofthe specification. The foregoing and other objects, features andadvantages of the invention will be readily understood from thefollowing detailed description taken in conjunction with theaccompanying drawings in which:

FIG. 1 is an exploded posterior, perspective view of one embodiment ofan elbow prosthesis, in accordance with an aspect of the presentinvention;

FIG. 2 is a posterior, elevational view of the elbow prosthesis of FIG.1, in accordance with an aspect of the present invention;

FIG. 3 is a anterior, elevational of the elbow prosthesis of FIG. 1, inaccordance with an aspect of the present invention;

FIG. 4 is an anterior, perspective view of the elbow prosthesis of FIG.1, in accordance with an aspect of the present invention;

FIG. 5 is cross-sectional-view taken along line 5-5 in FIG. 2, showingthe coupling mechanism between the ulnar component and the humeralcomponent of the elbow prosthesis of FIG. 1, in accordance with anaspect of the present invention;

FIG. 6A is a posterior view of one embodiment of a spherical shapedbearing body of a bearing end of the elbow prosthesis in FIG. 1, inaccordance with an aspect of the present invention;

FIG. 6B is a lateral view of one embodiment of a spherical shapedbearing body of a bearing end of the elbow prosthesis in FIG. 1, inaccordance with an aspect of the present invention;

FIG. 6C is a superior view of one embodiment of a spherical shapedbearing body of a bearing end of the elbow prosthesis in FIG. 1, inaccordance with an aspect of the present invention;

FIG. 7A is a posterior view of one embodiment of an elliptical shapedbearing body of a bearing end of the elbow prosthesis in FIG. 1, inaccordance with an aspect of the present invention;

FIG. 7B is a lateral view of one embodiment of an elliptical shapedbearing body of a bearing end of the elbow prosthesis in FIG. 1, inaccordance with an aspect of the present invention;

FIG. 7C is a superior view of one embodiment of an elliptical shapedbearing body of a bearing end of the elbow prosthesis in FIG. 1, inaccordance with an aspect of the present invention;

FIG. 8A is a posterior view of one embodiment of an oval shaped bearingbody of a bearing end of the elbow prosthesis in FIG. 1, in accordancewith an aspect of the present invention;

FIG. 8B is a lateral view of one embodiment of an oval shaped bearingbody of a bearing end of the elbow prosthesis in FIG. 1, in accordancewith an aspect of the present invention;

FIG. 8C is a superior view of one embodiment of an oval shaped bearingbody of a bearing end of the elbow prosthesis in FIG. 1, in accordancewith an aspect of the present invention;

FIG. 9A is a circular cross-sectional view of one embodiment of theulnar stem or humeral stem having a circular shape, in accordance withan aspect of the present invention;

FIG. 9B is a cross-sectional view of one embodiment of the ulnar stem orhumeral stem having a square shape, in accordance with an aspect of thepresent invention;

FIG. 9C is a cross-sectional view of one embodiment of the ulnar stem orhumeral stem having a rectangular or oblong shape, in accordance with anaspect of the present invention;

FIG. 9D is a cross-sectional view of one embodiment of the ulnar stem orhumeral stem having a trapezoidal shape, in accordance with an aspect ofthe present invention;

FIG. 9E is a cross-sectional view of one embodiment of the ulnar stem orhumeral stem having an elliptical shape, in accordance with an aspect ofthe present invention;

FIG. 9F is a cross-sectional view of one embodiment of the ulnar stem orhumeral stem having a quatrefoil shape, in accordance with an aspect ofthe present invention;

FIG. 10 is a posterior view of two embodiments of a total elbowprosthesis showing the extended medial and lateral aspects of the holderend of the humeral component, in accordance with an aspect of thepresent invention;

FIG. 11 is an exploded posterior, perspective view of another embodimentof an elbow prosthesis, in accordance with an aspect of the presentinvention;

FIG. 12 is a posterior, elevational view of the elbow prosthesis of FIG.11, in accordance with an aspect of the present invention;

FIG. 13 is an anterior, elevational of the elbow prosthesis of FIG. 11,in accordance with an aspect of the present invention;

FIG. 14 is an anterior, perspective view of the elbow prosthesis of FIG.11, in accordance with an aspect of the present invention; and

FIG. 15 is a flow chart of a method for performing an elbowarthroplasty, in accordance with an aspect of the present invention.

DETAILED DESCRIPTION FOR CARRYING OUT THE INVENTION

Disclosed herein is a total elbow prosthesis, a corresponding surgicalimplantation method and a total elbow prosthesis kit.

FIG. 1 is an exploded posterior view of a first embodiment of adisassembled elbow prosthesis 10 according to one aspect of theinvention. Elbow prosthesis 10 includes ulnar component 100 which mayinclude a bearing end 101 that has at least one projection/boss 102extending for example in the medial and/or lateral directions. As seen,projection 102 may have straight cylindrical side walls 105 tofacilitate insertion into the bearing member 300. Alternatively, sidewalls 105 may be tapered. The surface of side walls 105 is configured tomate and articulate with bearing member 300 and function as a means ofaligning ulnar component 100 relative to the humeral component 200.Bearing end 101 of ulnar component also includes a centralized bearingbody 103 that as seen may have a spherical-like shaped outer bearingsurface 104. Body bearing surface 104 is convex or has an arcuate shapeto facilitate rotational movement of ulnar component 100 relative tohumeral component 200 that mimics the natural elbow motion when thesecomponents are rotatably coupled. Bearing body 103 is comprised of bodybearing surface 104 and a mating surface 110.

As shown in FIG. 1, mating surface 110 is, for example, planar or flat,although it would be understood by one skilled in the art that othergeometric configurations could be used. As described below in moredetail, mating surface 110 is a component of the coupling mechanism 111.(See FIG. 5).

FIGS. 1 and 4 also show bearing end 101 including an offset neck 108that facilitates the replication of the mechanical and anatomicalorientation of elbow prosthesis 10 following implantation in the body.Neck 108 extends at an acute angle from the inferior aspect of bodybearing surface 104 and terminates at the stem connector member 107.Stem connector member 107 has a generally cylindrical cross-sectionalgeometry, although, alternatively, other polygonal cross-sectionalgeometric shapes may be used. The outer surface of stem connector member107 may be macrotextured, have a porous coated surface or include a bonegrowth surface coating, including for example TCP or HA. Stem connector107 is one aspect of the connecting mechanism 112 that also includes theproximal end of stem 106. Specifically, stem connector 107 includes aconnecting hole 109 that may be tapered or have a cylindrical internalshape to mate with an end of stem 106.

Ulnar component 100 also may include a distal projecting modular stem106 that may be attached to stem connector 107. Stem 106 will extend ina generally distal direction from stem connector 107 after stem 106 hasbeen inserted into connecting hole 109. It would be understood by oneskilled in the art that several connecting mechanisms 111 could be usedto connect the end of stem 106 to stem connector 107, including but notlimited to a morse taper, press-fit, a locking pin and a swag joint.Although not shown, an alternative embodiment of ulnar component 100 mayinclude stem 106 being integrally fixed to stem connector member 107.

As shown in FIGS. 1, 2, 3 and 4, stem 106 may be tapered to facilitateinsertion into the intramedullary canal of a bone. Alternatively,although not shown, stem 106 may be cylindrically shaped, include acurve or be matched anatomically with the intramedullary canal of thepatient into which device is being implanted.

As seen in FIGS. 2 and 3, longitudinal axis 113 of stem 106 is angledlaterally (valgus) ranging approximately between five and eight degrees,with a preferred range of between 6 and 7 degrees.

As shown in FIGS. 9A-9F, for both embodiments of elbow prosthesis 10,50, stems 106, 506 and the stem for the humeral component 203, 603 mayhave various polygonal cross-sectional geometries and sizes for each ofthe geometries. For example purposes, dimension “A” (for all geometries)may range between 2 and 14 mm, with a preferred range of 3-12 mm forstem 106, 506 while for stem 203, 603 the range may be 3-18 mm with apreferred range of 4-16 mm. Dimension “B” (for all geometries) for stem106, 505 may be between 2-14 mm, with a preferred range of 3-12 mm. Forstem 203, 603 the range may be between 2-16 mm, with a preferred rangeof 3-14 mm. As seen in FIGS. 3 and 13, the overall lengths “L” of stems106, 506 as measured from the center of rotation of the humeral holderend 201 to the tip 114, 514 will range between 35-150 mm, with apreferred range of 40-125 mm. For stem 203, 603, the length “LE” may bebetween 60-150, with a preferred range of 75-125 mm. Further, thesurfaces of stems 106, 506, 203, 603 may have various coatings ortreatment applied to them, including, but not limited to porous coating,bead blasting, generated integral nanosurfaces, HA coatings, TCPcoatings, BMP coatings and other well know bone growth facilitatingagents or substrate coatings.

As seen in FIGS. 1 and 11, stem 203, 603 may also be configured toaccommodate transverse fixation devices 209, 609, including screws,posts and pins. These transverse fixation devices 209, 609 may bedirected through bone on one side of the stem 203, 603 then enter hole212, 612 pass all the way through stem 203, 603 and exit into adjacentbone on the opposite side to provide immediate stability to implant 10,50. The fixation devices 209, 609 may be positioned in themedial-lateral or anterior-posterior direction.

Ulnar component 100 may be constructed from various biocompatiblematerials including metals (e.g., titanium, cobalt chromium), composites(PEEK), polymers (UHMWPE, Delrin) or elastomers, as well as combinationsof these materials.

FIGS. 6A-6C show one alternative embodiment of the configuration ofbearing end 101 and more specifically, the shape of centralized bearingbody 103. FIG. 6A is a posterior view of a spherical shaped bearing body103 that includes medial and lateral projections 102 and mating surface110. FIG. 6B is a lateral elevational view of bearing end 101 of FIG. 6Aand shows neck 108 extending from the inferior aspect of bearing body103 that connects to stem connector member 107. FIG. 6C is a superiorview of the bearing end 101 of FIG. 6A that shows mating surface 110. Asseen in all of these figures, stem connector member 107 includes amacro-textured surface.

FIGS. 7A-7C show a second alternative embodiment of the configuration ofbearing end 101 and more specifically, the shape of centralized bearingbody 103 is seen as an elliptical-like shape in the transverse plane.FIG. 7A is a posterior view of the elliptical shaped bearing body 103that includes mating surface 110. FIG. 7B is a lateral elevational viewof the bearing end 101 of FIG. 7A showing neck 108 extending from theinferior aspect of bearing body 103 to connect with stem connectormember 107. FIG. 7C is a superior view of the bearing end 101 of FIG. 7Athat shows the elliptical shaped mating surface 110. As seen in all ofthese figures, stem connector member 107 includes a macro-texturedsurface.

FIGS. 8A-8C show a third alternative embodiment of the configuration ofbearing end 101 and more specifically, the shape of centralized bearingbody 103 is seen as an oval-like shape in the transverse plane. FIG. 8Ais a posterior view of the oval shaped bearing body 103 that includesmating surface 110. FIG. 8B is a lateral elevational view of the bearingend 101 of FIG. 8A showing neck 108 extending from the inferior aspectof bearing body 103 to connect with stem connector member 107. FIG. 7Cis a superior view of the bearing end 101 of FIG. 8A that shows the ovalshaped mating surface 110. As seen in all of these figures, stemconnector member 107 includes a macro-textured surface.

FIGS. 1-4 further show in addition to ulnar component 100, humeralcomponent 200. Humeral component 200 includes a holder end 201 with aproximal extending stem 203. Holder end 201 is configured to generallyhave a yoke-like shape 216 with two arms 215 extending distally from thearch 217. Coupled to the distal end of arms 215 is a bearing holdermember 218 that has an inner surface 211 to which bearing member 300 isattached. The mechanism of attachment of bearing member 300 to innersurface 211 may include a snap lock, press fit or other similar design.Each bearing holder member 218 also includes a posterior directed notch220 through which bearing member 300 may slide during assembly ofimplant 10 to ensure proper orientation of bearing member 300 relativeto bearing holder 218 (see FIG. 2). Arms 215 are spaced apart at a setdistance 205 to accommodate bearing members 300 and the coupled bearingend 101 of ulnar component 100.

As seen in FIG. 4, positioned adjacent to arch 217 of yoke 216 is aflange 208. The opening of flange 208 is directed superiorly to allowfor the capture of tissue or bone when stem 203 is slid into theintramedullary canal of the humerus during implantation. Flange 208 isintegrally fixed to the anterior surface of stem 203, although it iscontemplated that flange 208 may be removable be positioned at variouspositions along the shaft of stem 203. As shown in FIG. 4, stem 203 mayinclude several holes 207 spaced apart along both the anterior andposterior (not shown) surfaces to accommodate modular flanges. Themodular flanges may be secured into holes 207 at various locations toaddress clinical circumstance and stabilize humeral component 200 withinthe bone. Additional stabilization may also be achieved by inserting ascrew or other bone fixation device 209 transverse to longitudinal axis219 through holes 212. (See FIG. 1). The use of screws or other bonefixation devices 209 will be dependent upon the quality of bone and theclinical situation presented.

As shown in FIG. 1, stem 203 is fixed to holder end 201, althoughalternatively, stem 203 may be modular and be secured in a similarmanner as is used for stem 106 of ulnar component 100 that has beendescribed above. Additionally, for the embodiment of humeral component200 that includes a modular stem, the stem may be tapered to facilitateinsertion into the intramedullary canal of a bone or alternatively, becylindrically shaped, include a curve or be matched anatomically withthe intramedullary canal of the patient into which humeral component 200is being implanted.

FIG. 1 further shows bearing member 300 that has an articulating surface301, a posterior directed slot 302, with a top surface or shelf 303.Articulating surface 301 is concave in shape to accommodate projections102 and bearing surface 104. Positioned generally at the apex of theconcavity of articulating surface 301 is an opening 304 to receiveprojections 102 and secure proper alignment between articulating surface301 and the bearing surfaces of projections 102 and bearing body 103.The outer surface 305 is configured in a manner that allows for secureattachment to inner surface 211 of bearing holder 218. Securement ofbearing member 300 to bearing holder 218 may be achieve using apress-fit, snap lock or other similar mechanism.

FIG. 5 is a cross-sectional view through the assembled implant 10showing coupling mechanism 111. Specifically, the sectional view showscentralized bearing body 103 inserted between bearing holders 218 andarticulating with bearing member 300 to comprise coupling mechanism 111.Also seen in FIG. 5 are projections 102 extending into the lateralopenings 304 of bearing member 300. Bearing surface 104 slides alongarticulation surface 301 when the prosthesis moves through a range ofmotion. An outer surface 305 of bearing member 300 is seen to beadjacent to inner surface 211 of bearing holder 218. Although not shown,inner surface is configured to secure bearing member 300 within theinner portion of bearing holder 218. Securement may be accomplishedusing a press-fit arrangement, snap-fit or a variable locking mechanism,like a pin or other similar mechanical configuration.

For example purposes, a snap-fit design may be comprised of severalcircumferentially positioned scallops or depressions disposed on innersurface 211 that are aligned with correspondingly positioned matingprotrusions on surface 305. The arrangement of depressions andprotrusions will ensure appropriate alignment and securement betweenbearing member 300 and bearing holder 218.

FIG. 5 depicts the internal arrangement of centralized bearing body 104,bearing member 300 and bearing holder 218, which comprise the couplingmechanism 111 during the coupling process. Externally, the couplingprocess is accomplished by initially aligning centralized bearing body103 with the holder end 201, but more specifically for prosthesis 10this involves aligning mating surface 110 of bearing body 103 with slot302 and top surface of slot 303 of bearing member 300 which ispositioned at about ninety degrees of hyperextension of the implant (twohundred and seventy degrees counterclockwise), as well as projections102 with notches 220. Once aligned, bearing body 103 is slid into slot302 that is positioned between arms 215 and aligned with notch 220.Mating surface 110 is slid across top surface or shelf of slot 303 whileprojections 102 slide into slot 303 until projections 102 come to restwithin holes 304. This type of arrangement being analogous to a keyedopening. Following the full nesting of centralized bearing head 103between bearing members 300, ulnar component 100 is then rotated fromninety degrees of hyperextension into extension and then flexion therebycausing mating surface 110 to no longer be aligned with top surface 303of slot 302 and locking ulnar component 100 and humeral component 200together, although allowing rotational movement along Line 5-5 of FIG.2.

FIGS. 11-14 show a second embodiment of the total elbow prosthesis 50.FIG. 11 is an exploded view showing ulnar component 500, bearing member700 and humeral component 600.

As seen in FIG. 11, ulnar component 500 may include a bearing end 501that has at least two tapered cylindrical projections 502 extending, forexample, in the medial and lateral directions. Each projection 502 has abearing surface 505 that will contact and articulate with an innerbearing surface 701 positioned within a cavity 611 of humeral housingmember 602. The bearing end 501 also has a centralized bearing body 503that may have a spherical-like shaped outer bearing surface 504. Thebody bearing surface 504 is curved or has an arcuate shape to facilitaterotational movement of ulnar component 500 relative to humeral component600, when these elements are coupled together to mimic the natural elbowmotion. Also disposed on centralized bearing body 503 is a matingsurface 510. For example purposes this is shown as a planar surface,although other distinctly shaped surfaces could be used. Mating surface510 is part of the coupling mechanism 511 and is configured to functionas a key element in that it must be aligned with a correspondingmatching surface in humeral component 600 and bearing member 700 toallow mating surface 510 to be slide into inner cavity 611 of humeralcomponent and then connect ulnar component 500 to humeral component 600.

FIGS. 11 and 14 also show a neck 508 extending from the inferior aspectof centralized bearing body 503. Neck 508 connects bearing body 503 withstem connector member 507. As seen, stem connector member 507 has amating or connecting hole 509 that is sized to receive a correspondingend of the distal extending stem 506.

As seen in FIG. 11, for example purposes, a taper lock is used to attachstem 506 to stem connector member 507, although it would be understoodby one skilled in the art that several coupling mechanisms could be usedfor this function, including but not limited to press-fit, a locking pinor a swag joint. Further, although not shown, stem 506 may also beintegrally connected to stem connector member 507. As already discussedabove for stem 106, having stem 506 be modular in construct providesmany advantages to the surgeon in addressing presented clinicalsituations. These advantages include being able to mix and match stem506 because of the availability of various lengths, diameters, shaftcurvatures, surface coatings and other structural changes that could beincorporated into a modular stem.

As seen in FIGS. 11, 12 13 and 14, stem 506 is generally straight in themedial-lateral direction, although it could be curved or angled in amedial, lateral, anterior or posterior direction to accommodate a bonydeformity. Stem 506 may have a surface coating or treatment applied toit, including porous coating, bead blasting, generated integralnanosurfaces, HA coatings, TCP coatings, BMP coatings and other wellknown bone growth facilitating agents or substrate coatings. As shown inFIGS. 12 and 13, stem 506 has a valgus angulation of between 5-8degrees, with a preferred range of between 6 and 7 degrees.

Ulnar component 500 may be constructed from various biocompatiblematerials including metals (e.g., titanium, cobalt chromium), composites(PEEK), polymers (UHMWPE, Delrin) or elastomers, as well as combinationsof these materials.

FIGS. 11, 12, 13 and 14 further exhibit humeral component 600. Humeralcomponent 600 includes a holder end 601 that includes a distal bearinghousing member 602. Distal bearing housing member 602 has an innercavity 611 with a circumferential slot 605 that transects in thesagittal plane, bearing housing member 602.

FIG. 11 shows inner cavity 611 being sized to receive bearing member700. Bearing member 700 is placed inside inner cavity 611 and is coupledto the inner wall of inner cavity 611 to secure bearing member 700 inposition. Such coupling is accomplished using a snap-fit, press-fit orother similar locking mechanism. Bearing member 700 has an inner bearingsurface 701 that is shaped to closely approximate and articulate withprojection bearing surface 505 and body bearing surface 504. Bearingmember 700 also includes a slot 702 that aligns with slot 605 of bearinghousing member 602 after insertion into inner cavity 611. Slots 605, 702are sized to accommodate the width of stem 506 and stem connector member507 when ulnar component 500 is rotated through a range of motion.Bearing member 700 further includes an outer surface 703 that ispositioned adjacent to an inner surface of inner cavity 611 when humeralcomponent 600 is assembled. Bearing member 700 is typically fabricatedfrom UHMWPE, although other bearing materials may be used.

As seen in FIG. 12, opening 606 is positioned on the posterior side ofbearing housing member 602. Positioned along the superior edge ofopening 606 is a notch 613 to facilitate the insertion of centralizedbearing body 503 into inner cavity 611. The combination of opening 606and notch 613 form a keyed opening that is part of coupling mechanism511 that is describe further below. Also shown in FIG. 12 is the stemtransition area 604 that provides for secure attachment of stem 603 tobearing housing member 602.

FIGS. 11 and 14 further show stem 603 being fixed to bearing housingmember 602 and extending in a proximal direction. Stem 603 may beavailable in various lengths and diameters that will allow the surgeonto customize the elbow prostheses to the clinical situation. Theselengths and cross-sectional geometries with dimension have beendiscussed above and are shown in FIGS. 9A-9F. Although the examplesshown provide for stem 603 to be integrally connect to bearing housingmember 602, it is understood that stem 603 may also be modular indesign, wherein it can be detached from bearing housing member 602 ortransition area 604 to allow for customization of stem size, length,curvature and surface coatings to address the large array of clinicalissue that may be presented to the operating surgeon.

Stem 603 is also configured to facilitate fixation to the humerus of thepatient. This may be accomplished via several modalities, including ananti-rotation flange 608 that may be inserted into ports 607 that arelocated along both the anterior and posterior aspects of stem 603 (seeFIG. 13). Flange 608 may be positioned at various locations proximallyfrom bearing housing member 602, for example, 1.5 cm, 2.5 cm and 3.5 cm.

As seen in FIG. 11, in addition to flange ports 607, a plurality ofholes 612 are spaced along the medial/lateral aspect of stem 603. Theseholes are sized to accommodate various transverse fixation devices 609,including for example, screws and pins, which when inserted provideimmediate securement of humeral component 600 to the patient's humerus.Generally, the transverse fixation device will inserted through one sideof the bone and pass through the stem 603 exiting into the contralateralside of the same bone to provide immediate stability.

The surface of stem 603 may also been coated or have been treated insome fashion to facilitate bone growth and enhance intramedullaryfixation. Several methods of surface coating or treatment may be usedincluding for example, porous coating, bead blasting, generated integralnanosurfaces, HA coatings, TCP coatings, BMP coatings as well as otherwell know in the art bone growth facilitating agents or substratecoatings.

FIGS. 12 and 13 show soft tissue attachment sites 610 on the lateralaspect of 621 of bearing housing member 602. Attachment sites 621 areshown as a hole sized to accommodate various soft tissue connectingmechanisms, including for example, sutures, anchors, clips, tabs andbuttons.

Coupling mechanism 511 for prosthesis 50, operates similar to prosthesis10 through the use of a uniquely configured keyed opening 606 positionedon the posterior aspect of bearing housing member 602 or approximately270 degrees counter-clockwise relative to the attachment site of stem603. More specifically, the mechanism involves aligning at about ninetydegrees of hyperextension of the prosthesis 50 mating surface 510 withopening 606 of bearing housing member 602. If exact alignment is notachieved, mating surface 510 cannot slide through opening 606 and intoinner cavity 611. Once aligned, centralized bearing body 503 is advancedinto inner cavity 704 of bearing member 700 that is positioned insideinner cavity 611, and projections 502 and centralized bearing body 503are nested within inner cavity 704. Ulnar component 500 is then rotatedto full extension, resulting in mating surface 510 no longer beingaligned and thereby causing the ulnar and humeral components to bemoveably connected to form total elbow prosthesis 50.

Essentially, after insertion, centralized bearing body 503 isencapsulated or captured by inner cavity 704 to facilitate smoothsliding articulation between ulnar component 500 and humeral component600. Positioning opening 606 in the posterior location results in ulnarcomponent 500 being anatomically constrained post-implantation, fromrotating to the location of opening 606 and possibly decoupling fromhumeral component 600.

Humeral component 600 may be constructed from various biocompatiblematerials including metals (e.g., titanium, cobalt chromium), composites(PEEK), polymers (UHMWPE, Delrin) or elastomers, as well as combinationsof these materials.

FIG. 10 a posterior view of two embodiments of the total elbowprosthesis showing extended medial and lateral aspects of holder end201, 601 of the humeral component. Positioned on the extended medial andlateral aspects 221, 621 of holder end 201, 601 are means for attachmentof soft tissue 210, 610, including ligaments, tendons and otherstabilizing structures. As shown in FIG. 10, the means for attachmentare through holes 210, 610 that allows the surgeon to pass through wiresor sutures to connect the anatomic structures directly to humeralcomponent 200, 600. Additional means of attachment may be positionedalong the extended medial and lateral aspects, including, but notlimited to tabs, hooks and slots.

The example surgical method for using elbow prosthesis 10, 50 is wellknown in the art, including the appropriate surgical exposure anddissection techniques. As described in FIG. 15, the method 1000includes, obtaining an elbow prosthesis 1010 that may include an ulnarcomponent, a humeral component and at least one bearing member. Themethod 1000 may include the step of making an incision in the patient atthe elbow 1020 and using for example, a triceps sparing approach or thetriceps off technique.

Upon exposing the elbow, the surgeon will look and assess the conditionof the ulna and humerus to determine the degree of hard and soft tissueresection that may be necessary 1030. The integrity of the surroundingsoft tissue is evaluated to determine if further repairs may benecessary, as well making every attempt to preserve the supportingligamentus structures.

The method 1000 may then include the step of determining the appropriatesize of ulnar component and humeral component using diagnostic imagingand sizing trials 1040.

The method 1000 may include the step of resecting the distal end of thehumerus or removing fracture fragments to expose the distal end 1050.

A further step of the method 1000 may include preparing the humeralcavity and the ulnar cavity to allow for implantation of the twocomponents 1060. Various sizes of rasps and/or broaches withself-centering reamers or other canal cutting devices may be used aswell as a guiding/drilling device may be utilized to ensure properplacement and alignment of the humeral component and if necessary,distal/proximal fixation devices that may be inserted transverse to thestems of the humeral and ulnar components.

Following cavity preparation, the method 1000 may include the step ofimplanting the trials for the humeral component and the ulnar componentto assess soft tissue balance, range of motion, joint spacing andstability 1070.

The method 1000 may further include the step of implanting the humeralcomponent and securing the component within the intramedullary canal aswell as coupling the ulnar component to the implanted humeral component1080. Depending on the state and integrity of the surroundingsoft-tissue, the step may also include attaching or coupling thenon-implanted ulnar component to the implanted humeral component. Thecoupling process would be accomplished by aligning the couplingmechanism 111 which includes the centralized bearing body with theholder end, but more specifically for prosthesis 10 this involvesaligning mating surface 110 of bearing body 103 with slot 302 and topsurface of slot 303 of bearing member 300 which is positioned at aboutninety degrees of hyperextension of the implant. Once aligned, bearingbody 103 is inserted between arms 215 and is positioned adjacent tobearing members 300. For prosthesis 50, this involves aligning at aboutninety degrees of hyperextension of the implant, bearing body 503 withopening 606. Once aligned, bearing body 503 is inserted into innercavity 611 and ulnar component 500 is rotated to full extension,resulting in the two components being moveably connected.

Following the implantation of the humeral component and the coupling ofthe ulnar component to the humeral component, the next step may be toinsert and secure in the prepared intramedullary canal of the ulna theulnar component 1090. A guiding/targeting system may be used forinsertion of any proximal/distal fixation devices through the ulnarstem.

The sequence of implanting the ulnar and humeral components may varydepending on surgeon preference and the clinical presentation of theanatomy. Further, the surgeon may also decide to delay the componentcoupling step until both components are implanted within the ulna andhumerus and then hyper-extend the ulna to a point approaching ninetydegrees past full extension at which time the coupling mechanism can beactuated, thereby securing the two components together andreestablishing connectivity of the joint. This alternative couplingprocedure is dependent upon the clinical condition of the presentedelbow joint.

The method 1000 may also include the step of attaching the surroundingsoft tissue to the elbow prosthesis and balancing the soft tissuestructures to reestablish the joint range of motion and stability 1100.

Upon completion of the joint assessment and observation of thefunctionality of the implant, including fixation of the componentswithin the ulna and humerus, the step of closing the incision istypically taken 1110.

It would be understood to those skilled in the art that a surgical kitthat includes a plurality of various sizes of ulnar and humeralcomponents including modular stems, antirotation flanges and fixationdevices may be obtained by the surgeon instead of a single elbowprosthesis to allow for additional flexibility during the operativeprocedure. Corresponding component trials, broaches, canal centralizingstyle reamers, soft tissue anchoring devices, including sutures andother devices, and a guiding system for fixation device targeting andimplantation may also be part of such a kit.

In accordance with another aspect of the present invention, a totalelbow prosthesis kit is described herein. The kit may include aplurality of humeral components, each having a different sized andconfigured proximal stems. The proximal stems may be either integrallyfixed to the holder end, or alternatively, the proximal stems may bemodular and configured to be detachably coupled to the holder end. Asdescribed above, the modular proximal stem embodiments may have variouslengths, diameters, cross-sectional geometries, coatings, fixationlocations and linearity over the length of the stem. The kit may alsoinclude for the modular humeral design, various sizes and configurationsof the holder end, including width, thickness and outside configuration.

The kit may also include, a plurality of ulnar components, each having adifferent sized and configured distal stem. Distal stems may beintegrally fixed to bearing body, or alternatively, distal stems may bemodular and configured to be detachably coupled to the bearing body.Distal stems may have various lengths, diameters, cross-sectionalgeometries, coatings, fixation locations and linearity over the lengthof the stem. Also, the distal stems may be configured with threads orother fixation mechanisms, like circumferential flanges, fins, ribs,etc. to gain immediate fixation within the intramedullary canal of theulna. When the distal stem is configured as a screw like member, thestem will include a head that will lock within the stem connectormember. The kit may also include a plurality of threaded distal stemsthat have varying thread patterns, pitches and thread types and depths.(i.e., cancellous threads and cortical threads).

The kit may further include a plurality of detachably coupledanti-rotation flanges that may be fixed to either the humeral proximalstem and/or the ulnar distal stem. Additionally, the kit may alsoinclude various sized transverse fixation devices that may beconfigured, for example, as screws, pins and posts.

The kit may include a corresponding trial system for the ulnar andhumeral components, with the trials matching the implants to allow theoperating surgeon the ability to use the trials to ensure proper sizing,range of motion and soft-tissue balancing. Other associatedinstrumentation would be included in the kit, including, for example, aguiding/targeting/drilling instrument for use to ensure proper placementof any fixation devices through the stems of the components. Rasps,broaches, self-centering canal reamers and cutting jigs for boneresection and preparation of the humeral and ulnar intramedullary canalswill also be included in the kit. Additionally, tissue attachmentmechanisms and devices may also be included in the kit. Examples ofthese devices include sutures, buttons, tacks, anchors. These deviceswould facilitate attachment of the surrounding soft-tissue to theimplanted elbow prosthesis.

Although the example embodiments have been depicted and described indetail herein, it will be apparent to those skilled in the relevant artthat various modifications, additions and substitutions can be madewithout departing from its essence and therefore these are to beconsidered to be within the scope of the following claims.

What is claimed is:
 1. A method for using an elbow prosthesis in apatient, the method comprising: obtaining the elbow prosthesiscomprising: an ulnar component having a bearing end and a stem, whereinthe stem is coupled to the bearing end and extends away from the bearingend; a humeral component having a holder end and a stem, wherein thestem extends away from the holder end; and at least one bearing membercoupled to the holder end; wherein the bearing end is configured to becoupled within the holder end to articulate against the at least onebearing member; making an incision in the patient; determining theproper size for the ulnar component and the humeral component; preparingan ulna and a humerus of the patient; securing the humeral componentinto the humerus of the patient; attaching the ulnar component to thehumeral component comprises: rotatably coupling the ulnar component tothe humeral component; and securing the at least one bearing member toan inner surface of the holder end; rotating the ulnar component fromninety degrees of hyperextension with respect to the humeral componentinto extension; rotating the ulnar component from extension into flexionto couple the ulnar component to the humeral component; securing theulnar component into the ulna of the patient; and closing the incisionin the patient.
 2. The method of claim 1, further comprising: assessingthe condition of the ulna and the humerus to determine the degree ofhard and soft tissue resection.
 3. The method of claim 1, whereindetermining the proper size for the ulnar component and the humeralcomponent comprises using at least one of diagnostic imaging and sizingtrials.
 4. The method of claim 1, wherein preparing the humerus of thepatient comprises resecting a distal end of the humerus and removingfracture fragments to expose the distal end of the humerus.
 5. Themethod of claim 1, further comprising: implanting trials for the humeralcomponent and the ulnar component; and assessing at least one of softtissue balance, range of motion, joint spacing, and stability.
 6. Amethod for using an elbow prosthesis in a patient, the methodcomprising: obtaining the elbow prosthesis comprising: an ulnarcomponent having a bearing end and a stem, wherein the stem is coupledto the bearing end and extends away from the bearing end; a humeralcomponent having a holder end and a stem, wherein the stem extends awayfrom the holder end; and at least one bearing member coupled to theholder end; wherein the bearing end is configured to be coupled withinthe holder end to articulate against the at least one bearing member;making an incision in the patient; determining the proper size for theulnar component and the humeral component; preparing an ulna and ahumerus of the patient; securing the humeral component into the humerusof the patient; attaching the ulnar component to the humeral component;securing the ulnar component into the ulna of the patient prior toattaching the ulnar component to the humeral component, wherein the ulnawith the secured ulnar component is hyper-extended to enable actuationof the bearing end relative to the holder end to couple the ulnarcomponent to the humeral component; and closing the incision in thepatient.
 7. The method of claim 1, further comprising: using a guidingsystem for inserting at least one fixation device into the stem of theulnar component.
 8. The method of claim 1, further comprising: attachingsurrounding soft tissue structures to the elbow prosthesis.
 9. Themethod of claim 8, further comprising: balancing the soft tissuestructures of the elbow of the patient.
 10. The method of claim 9,further comprising: assessing the joint and functionality of theimplanted elbow prosthesis.
 11. A method for implanting an elbowprosthesis in a patient, the method comprising: obtaining an elbowprosthesis comprising: an ulnar component having a bearing end and astem, wherein the stem is coupled to the bearing end and extends in adistal direction from the bearing end; a humeral component having aholder end and a stem, wherein the stem extends in a proximal directionfrom the holder end; and a coupling mechanism, the coupling mechanismcomprises at least one bearing member, the bearing end, and the holderend; wherein the at least one bearing member is positioned within theholder end and the bearing end is configured to be rotatably coupledwithin the holder end and articulate against the at least one bearingmember; making an incision in the patient; determining the proper sizefor the ulnar component and the humeral component; preparing an ulna anda humerus of the patient; securing the humeral component into thehumerus of the patient and rotatably coupling the ulnar component to thehumeral component; securing the at least one bearing member to an innersurface of the holder end by positioning the at least one bearing memberat approximately ninety degrees of hyperextension from the humeralcomponent; inserting the bearing end of the ulnar component into theholder end of the humeral component adjacent to the at least one bearingmember; rotating the ulnar component relative to the humeral componentto lock the ulnar component to the humeral component; securing the ulnarcomponent in the ulna of the patient; and closing the incision in thepatient.
 12. A method for inserting an elbow prosthesis in a patient,the method comprising: obtaining the elbow prosthesis, the prosthesiscomprising: an ulnar component having a bearing end and a stem, whereinthe stem is coupled to the bearing end and extends in a directionopposite the bearing end, and wherein the bearing end comprises abearing body, the bearing body having a bearing surface and a matingsurface, the bearing surface is convex and configured as one of aspherical shape, an oval shape or an elliptical shape, and the matingsurface is substantially planar; a humeral component having a holder endwith at least one bearing member coupled to the holder end, a stem, andat least one arm connecting the at least one bearing member to the stem,wherein the stem extends in a direction opposite the holder end; and acoupling mechanism, the coupling mechanism comprises the at least onebearing member, the bearing body, and the holder end, wherein the atleast one bearing member is positioned within an opening disposed on aposterior aspect of the humeral component and the corresponding matingsurface disposed on the bearing body; the bearing end is configured tobe coupled within the holder end and slide against the at least onebearing member; the bearing body further comprising a means foralignment with the at least one bearing member; and the means foralignment comprising at least one projection extending away from thebearing surface in at least one of a lateral or medial direction; makingan incision in the patient; determining the proper size for the ulnarcomponent and the humeral component; preparing the ulna and the humerusof the patient; securing the humeral component into the humerus of thepatient and coupling the ulnar component to the humeral component;securing the ulnar component in the ulna of the patient; and closing theincision in the patient.
 13. The method of claim 12, wherein attachingthe ulnar component to the humeral component comprises coupling theulnar component to the humeral component secured into the humerus of thepatient.
 14. The method of claim 13, wherein coupling the ulnarcomponent to the humeral component comprises aligning the couplingmechanism.
 15. The method of claim 14, wherein aligning the couplingmechanism comprises aligning the mating surface of the bearing body withat least one slot of the at least one bearing member, inserting thebearing body between the at least one arm, and positioning the bearingbody adjacent to the bearing members.
 16. A method of assembling anelbow prosthesis, the method comprising: obtaining an ulnar componentcomprising a bearing end and a stem, wherein the stem is coupled to thebearing end and extends distally from the bearing end and the bearingend comprises at least one projection extending in at least one of alateral or medial direction from the bearing end; obtaining a humeralcomponent comprising a holder end and a stem, wherein the stem extendsproximally from the holder end and the holder end comprises at least onenotch; obtaining at least one bearing member with an articulatingsurface and a slot extending from an exterior side of the bearing memberinto the articulating surface; inserting the at least one bearing memberinto the holder end of the humeral component; positioning the at leastone bearing member at approximately ninety degrees of hyperextensionrelative to the humeral component; aligning a mating surface of thebearing end with the slot of the at least one bearing member andaligning the at least one projection with the at least one notch;sliding the at least one projection of the bearing end into the slot ofthe at least one bearing member and the at least one projection into theat least one notch; and rotating the ulnar component with respect to thehumeral component to secure the ulnar component to the humeralcomponent.
 17. The method of claim 6, further comprising: assessing thecondition of the ulna and the humerus to determine the degree of hardand soft tissue resection.
 18. The method of claim 6, whereindetermining the proper size for the ulnar component and the humeralcomponent comprises using at least one of diagnostic imaging and sizingtrials.
 19. The method of claim 6, wherein preparing the humerus of thepatient comprises resecting a distal end of the humerus and removingfracture fragments to expose the distal end of the humerus.
 20. Themethod of claim 6, further comprising: implanting trials for the humeralcomponent and the ulnar component; and assessing at least one of softtissue balance, range of motion, joint spacing, and stability.
 21. Themethod of claim 6, further comprising: using a guiding system forinserting at least one fixation device into the stem of the ulnarcomponent.
 22. The method of claim 6, further comprising: attachingsurrounding soft tissue structures to the elbow prosthesis.
 23. Themethod of claim 22, further comprising: balancing the soft tissuestructures of the elbow of the patient.
 24. The method of claim 23,further comprising: assessing the joint and functionality of theimplanted elbow prosthesis.